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Every month, one of your ovaries releases an egg into the fallopian tube. If you don’t become pregnant, the lining of your uterus sheds and your menstrual period arrives. But if an egg becomes fertilized with sperm, it makes its way to the uterus, where it implants into the uterine lining and continues to grow into a fetus. However in the case of an ectopic pregnancy (also known as a tubal pregnancy), the fertilized egg implants outside the uterus, where it cannot continue to develop normally. An estimated 97 percent of ectopic pregnancies occur in one of the fallopian tubes, though they can also happen in the cervix, on an ovary or in the abdomen.

Ectopic pregnancies, which account for approximately 2 percent of all pregnancies, often occur because the egg’s movement through the fallopian tube is slowed or obstructed (usually because of scarring). This condition happens early in pregnancy — before some women even realize they’re pregnant — and requires prompt treatment, since as an ectopic pregnancy grows it can rupture the fallopian tube and cause life-threatening internal bleeding. If you suspect an ectopic pregnancy, don’t wait to call your practitioner. The good news? With a timely diagnosis and care, you have a very good chance of having a healthy pregnancy in the future.

Symptoms

Ectopic pregnancy can be hard to diagnose, since many of the symptoms — including breast tenderness, nausea or fatigue — are similar to normal early pregnancy symptoms. So although occasional cramping and slight vaginal spotting is not cause for alarm even during pregnancy, contact your practitioner if you experience the following, especially if your symptoms persist or worsen:

Sharp, crampy abdominal pain, usually in the lower abdomen (it often begins as a dull ache that progresses to spasms and cramps); pain may be continual or intermittent, and it may worsen with movement, straining of bowels or coughing

If the ectopic pregnancy goes unnoticed and a fallopian tube ruptures, you may experience:

Heavier bleeding

Increasing abdominal pain

Severe sharp abdominal pain

Rectal pressure

Vomiting

Low blood pressure due to blood loss

A feeling of faintness, weakness or dizziness due to blood loss

Shoulder pain due to the accumulation of blood under the diaphragm

How it’s diagnosed

An ectopic pregnancy is usually diagnosed at about four to six weeks into pregnancy, typically through an ultrasound to locate the pregnancy and blood tests to check the level of the pregnancy hormone human chorionic gonadotropin (HCG). A lower than normal increase in HGC levels may indicate an ectopic pregnancy.

How it’s treated

Unfortunately, there’s no way to preserve an ectopic pregnancy. There are several options to treat it, all of which require careful follow-up with your doctor to ensure your hCG levels drop back down to zero:

Medication. The smallest ectopic pregnancies — where a fetal heartbeat is not present and a fallopian tube has not ruptured — can be treated with methotrexate. Following a shot of this medication, you’ll undergo important follow-up blood tests to ensure hCG levels are decreasing appropriately. If your hCG level does not drop by at least 15 percent between the fourth to seventh day after treatment, the medication didn’t and a second dose is required. It’s important to avoid alcohol, folic acid and pain medications like ibuprofen to ensure the medication works correctly. During the process, which can take about four to six weeks, the ectopic pregnancy can still rupture, which is why it’s so important to make sure to make your doctor’s appointments and follow her instructions for follow-up care. By some estimates, up to 90 percent of ectopic pregnancies can be treated with medication alone if caught early enough.

Laparoscopic surgery. In most other cases when medication is not appropriate, your practitioner may perform surgery under general anesthesia to remove an ectopic pregnancy. The surgery can be done using a laparoscope (a thin-light transmitting instrument with a camera) that’s inserted through small incisions in the abdomen. It allows surgeons to see inside without having to make larger incisions, while surgical instruments are used to remove the pregnancy. In some cases where the fallopian tube has ruptured, part or all of it may need to be removed. Women usually leave the hospital within 24 hours, and the recovery time is a week or two.

Laparotomy. Sometimes a bigger incision is needed to remove an ectopic pregnancy. In this case, you’d leave the hospital in a day or two, and your recovery time would be about six weeks.

Complications

Without early diagnosis of an ectopic pregnancy and treatment, a fertilized egg can continue to grow in the fallopian tube, leading to a rupture. If a fallopian tube bursts, it cannot carry a fertilized egg to the uterus in the future. And if a rupture is uncared for, it can result in severe, even life-threatening, internal bleeding and shock. The good news is with early detection, medication or surgery can remove the tissue before these complications occur — so always be sure to let your doctor know right away if you’re experiencing any symptoms you think may be related to an ectopic pregnancy.

Risk factors

Although any woman can develop an ectopic pregnancy, those who are over the age of 35 and who smoke are at increased risk of ectopic pregnancy, as are women who have:

Endometriosis

Pelvic inflammatory disease

Had a prior ectopic pregnancy

Had tubal surgery, including having your tubes tied (the likelihood increases two or more years after the procedure)

Become pregnant while using an IUD (using an IUD does not increase your risk of ectopic pregnancy, and an ectopic pregnancy with an IUD is extremely rare — but if you do conceive with an IUD in place, your risk of ectopic pregnancy is higher)

If you are at increased risk for an ectopic pregnancy, be sure to see your doctor before you start trying to become pregnant, and schedule a visit as soon as you find out you’re expecting.

Preventing ectopic pregnancy

Anytime you’re trying to get pregnant, the best way to stay healthy is to exercise, eat well and remember to take a daily prenatal vitamin. And although some factors are out of your control, there are a few ways you can decrease your risk of ectopic pregnancy:

Don’t smoke

If you're not currently trying to get pregnant, use condoms to help prevent contracting a sexually transmitted disease (and get tested if you are at risk of contracting an STD so you can get treated promptly)

See your doctor for possible treatment if you suffer from endometriosis

Coping with loss

Although it occurs early on, an ectopic pregnancy is a loss just like any other miscarriage — especially if you’ve been planning for a child. You may feel sad or shocked, and healing emotionally can take time. Lean on your friends and family for support, consider a support group or grief counseling, and read here for more on how to cope emotionally after a miscarriage.

Getting pregnant again

Having an ectopic pregnancy should have little bearing on your future fertility. Even if you lost a fallopian tube to an ectopic pregnancy, the other tube should take over. An estimated 60 percent of women treated for ectopic pregnancy will conceive and have a normal pregnancy within a year (the typical rate of pregnancy among women who haven’t had an ectopic pregnancy is about 84 to 89 percent). More good news: A recent European study found that a woman’s fertility remains intact regardless of whether her ectopic pregnancy was treated with medication, surgery that preserved a fallopian tube or surgery that removed it. However be aware that having one ectopic pregnancy does increase your risk of having another one, and the same factors that led to your ectopic pregnancy may be still at work.

If you’d like to try and get pregnant again, make sure to see your practitioner for a checkup and follow-up blood tests first to make sure the pregnancy hormone has dropped to an undetectable level. It may be a good idea to wait until you’ve had three to six menstrual cycles before trying to get pregnant again.

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